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1 Quality Improvement Plan (QIP) Narrative for Health Care Organizations in Ontario 4/1/2015 This document is intended to provide health care organizations in Ontario with guidance as to how they can develop a Quality Improvement Plan. While much effort and care has gone into preparing this document, this document should not be relied on as legal advice and organizations should consult with their legal, governance and other relevant advisors as appropriate in preparing their quality improvement plans. Furthermore, organizations are free to design their own public quality improvement plans using alternative formats and contents, provided that they submit a version of their quality improvement plan to Health Quality Ontario (if required) in the format described herein. 1

2 Overview Once again, the North Muskoka Nurse Practitioner-Led Clinic has had a fantastic year providing high-quality patient-centred primary health care. With a client base that has grown to more than 2250 people, the NPLC team has maintained same or next day service for the vast majority of clients. In 2014/2015, the NPLC received exceptional feedback for client centredness, providing clients with the time they need, the opportunity to ask questions and involving clients in their care decisions to the degree that they desire. Over the next fiscal year, the North Muskoka NPLC will aim to maintain this excellent record of high quality care while implementing improvements that align with Ontario s Action Plan for Healthcare. Our priorities, outlined in the workplan attached, aim to keep clients healthy, ensure access to care when needed and encourage/provide up-to-date cancer screening that saves lives. The NPLC will continue to work with community partners to ensure that hospital visits are tracked and reviewed. We will help maintain a low rate of ER visits for cases best managed elsewhere and will ensure that clients with complex needs have a follow up plan in place before they are discharged from the hospital. To receive valuable feedback in 2015/2016, the NPLC will implement a revised client experience survey with the goal of obtaining feedback from 10% of the registered client base. This feedback will guide future change initiatives and ensure that the work being done by the clinic to improve quality is of value to the clients. Over the past fiscal year, the North Muskoka NPLC has been providing fantastic, high-quality primary health care; we look forward to continuing this challenging and rewarding work in the next fiscal year. Integration & Continuity of Care When continuity and integration are done well client safety and satisfaction is high; efficiency is maximized. These concepts become critically important when a person's health or social concerns are complex. The North Muskoka NPLC provides continuity of care by linking each registered client with one Primary Care Nurse Practitioner. Each NP sees his or her own clients >90% of the time. Each NP is actively involved in direct client care, education, advocacy and care coordination. Consistent documentation and communication are key components that drive success; success that is measured through client feedback and hospital utilization analysis. Over the past year, the clinic started developing coordinated care plans with clients, families, community support groups, specialists, hospitals, CCAC and others. The care planning process allows team members to better understand client concerns and goals. It encourages the sharing of information across organizations. Using these plans there has been a reduction ER use and hospital visits. This care planning will continue and expand over the next fiscal year. Outside of direct client visits, the NPLC has advocated for excellent health care through involvement with the Muskoka Health Links [HL] Steering Committee, HL System Navigation Committee, HL Health Hub Implementation Committee, Muskoka Mental Health Therapists Group, North Simcoe Muskoka Self-Management Coalition, Muskoka Senior s Planning Council, Elder Abuse Network Muskoka, Cancer Care Ontario s Primary Care Teams (Prostate and Breast Cancer), Muskoka Regional Diabetes Care 2

3 Group, Muskoka Algonquin Healthcare Master Planning Committee, Muskoka Breastfeeding Coalition, Association of Ontario Health Centres, Association of Ontario Social Workers, Nurse Practitioner s Association of Ontario and many other important and forward-focused committees. Each of these groups enrich our team s ability to understand the complex system that clients are navigating and the opportunities to simplifying client transitions and care. We are excited to be continuing our work in facilitating positive change across Muskoka and provincially. Challenges, Risks & Mitigation Strategies At this time, the most substantial risk facing the NPLC is staff retention. Losing our valued, knowledgeable, experienced and trusted staff would be detrimental to client satisfaction and clinic function. Attempting to recruit in a rural community with competing vacancies and significant wage discrepancies would absolutely affect the clinic's ability to provide ongoing high-quality care. Nurse Practitioners in primary care have not had an increase in salary since the 2.25% that was awarded in These NPs are now amongst the lowest paid in Canada despite the expanded scope, degree of responsibility and high quality care they provide. Currently, NPLC salaries are up to 35% lower than in other sectors (hospital and CCAC) and since the clinic opened in 2012, there has been no ability to provide raises, including cost of living, to any staff as requests for increases have all been declined. There is no pay available for overtime, afterhours, on call or weekend service which staff do provide without remuneration. There is no funding mechanism for staff coverage which translates into additional work for each member in the event of a staff vacation or absence. Thus, NPLC leadership must continually consider staff satisfaction as paramount and balance the demands against the competition of outside organizations actively recruiting NPs. We fear the situation as it exists is not sustainable. In addition to fiscal concerns, the North Muskoka NPLC fundamentally recognizes that people with the most complex needs require coordinated services and team based care the most. Unfortunately, it has been our experience that those with the most complex needs are the ones most likely to be unattached. Thus, the NPLC client base overall has very complex health and socioeconomic needs; the risk for staff burnout is very high. Mitigation strategies at this time include favouring quality of care over quantity of clients, expressing gratitude daily recognizing staff dedication, empowering staff to take control of their schedules, processes and workloads, requesting feedback and making daily changes to improve quality, working together to share complex caseloads, scheduling staff retreats and team building exercises, keeping office hours to encourage a satisfying work/life balance and allowing time for staff administrative work and reflective practice. Information Management Systems The NPLC uses the EHR Nightingale. Each client has one chart that all team members use for documentation and information management. The clinic has recently obtained access to Hospital Report Manager which imports diagnostic imaging results, admission and discharge summaries in real time. This has been extremely valuable in clinical practice. The EHR is also linked with OLIS which imports lab reports from community labs across the province in real time. The EHR is used to house all client information, including all visits, diagnoses, treatments, tests, prescriptions and consultation records. This allows for 3

4 excellent record keeping and accurate retrival of information by all members involved in a client's care. Currently the NPLC is working with the Muskoka Health Links Steering Committee to develop a regional electronic solution with a goal of allowing electronic data sharing across health care partner organizations within Muskoka (i.e. CCAC, MAHC). We look forward to changes expected over the next year. Engagement of Clinical Staff & Broader Leadership All staff of the NPLC have been involved in providing high quality care, reviewing options for change and quality improvement, evaluating our care and reviewing quality care performance indicators on a regular basis. Communication is key in developing a plan which has a high degree of buy-in and dedication. Our broader leadership is spearheading change initiatives with a quality agenda and the board is kept abreast of the progress on a quarterly basis. Patient/Resident/Client Engagement The North Muskoka NPLC QIP takes into account the needs of clients as it is their health care experiences that guide our journey through change. Surveys received over the past fiscal year (in addition to baseline data collected through the EHR) have been considered in the development of this year's QIP and improvement priorities. Patient engagement will be enhanced over the next fiscal year through the expansion of the Client Experience Survey with a goal of obtaining feedback from 10% of the client base. We will also aim to have client representation on our board of directors over the next fiscal year. Clients, their families and caregivers will have access to our QIP on our clinic website and will be encouraged to talk to the staff, leadership and board about their priorities for change. Accountability Management The QIP is a tool that NPLC leadership uses to gather data about the care provided, analyze opportunities for meaningful change, share information with others and highlight successes and challenges in providing client centred care. The QIP also provides an opportunity to ensure that client feedback is obtained and used in the evaluation of services. Obtaining the goals set out in the QIP is a mulitfactoral process requiring the engagement and participation of clients, staff, leadership, board members, local health care organizations and the government through policy analysis and change. Leadership at the NPLC is committed to clarifying the NPLC purpose, aligning the systems, unleashing the talent and inspiring the trust of the clients, the staff and the community at large. The goals of the QIP will be reviewed regularly and any difficulty attaining these goals will be explored and explained. Other The North Muskoka NPLC looks forward to another very successful year providing high quality primary health care. Sign-off It is recommended that the following individuals review and sign-off on your organization s Quality Improvement Plan (where applicable): 4

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